Download Bone Cancer - Knee Differential Diagnosis

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Bone Cancer
Development of Bone Cancer
• Advancing age and a previous history of cancer are
the two most important risk factors for cancer
• Primary bone cancer is uncommon; however, the
skeleton is the most common organ affected by
metastatic cancer.
• Primary cancers of the breast, prostate, thyroid,
lung, and kidney commonly metastasize to the bone.
• Cancer is more likely to metastasize to the vertebrae,
pelvis, ribs, skull, proximal femur, sternum, or
cervical spine.
• Bone pain in the lumbar spine or proximal femur
can refer pain to the knee.
Common Risk Factors
• Age over 50 years
• Ethnicity: racial minorities and ethnic groups
are at an elevated risk
• Family history
• Environment and lifestyle
Presentation of Bone Cancer
Deep pain
Poorly localized
Pain increases with activity
Pain description: burning, aching, stabbing
Pain is cyclic and progressive until it becomes constant
Decreased tolerance to weight bearing
Antalgic patterns.
Bone pain does not respond well to physical agents
Soft tissue swelling
Pathologic fractures
Back or rib pain
Additional Signs and Symptoms
• Unexplained changes in appetite
• Unexplained weight gain or loss of 10% of total
body weight within the last 4 weeks
• Proximal muscle weakness
– if the nerves are compressed
• Change in two or more deep tendon reflexes
• Palpable lump or mass
• Pain present at night, unrelieved by change in
Tests to Differentiate
• Heel strike test
– Pain reproduced is indicative of a fracture
– Fractures can also be associated with tumors
• Pain that subsides with salicylates is
characteristic of an osteoid osteoma
– Osteoid osteoma is a benign
osteoblastic tumor that commonly
occurs in the diaphysis of long bones
• Occurs usually between ages 7 to 25
• Refer to primary care physician for further
• Siegenthaler, Walter. 2007. Siegenthaler’s
Differential Diagnosis in Internal Medicine:
From Symptom to Diagnosis. Georg Thieme
Verlag. Stuttgart, Germany. 1144 pages.